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A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage

  • Jung-Ho Lee and Dae-Hwan Lee EMAIL logo
Published/Copyright: October 27, 2023
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Open Medicine
From the journal Open Medicine Volume 18 Issue 1

Abstract

This study was conducted to investigate the effects of anti-gravity treadmill (AGT) training, which provides visual feedback and Biorescue training on proprioception, muscle strength, balance, and gait, in stroke patients. A total of 45 people diagnosed with post-stroke were included as study subjects; they were randomized to an AGT training group provided with visual feedback (Group A), a Biorescue training group provided with visual feedback (Group B), and an AGT/Biorescue group that subsequently received AGT training and Biorescue training (Group C). A muscle strength-measuring device was used to evaluate muscle strength. Timed Up and Go and Bug Balance Scale assessment sheets were used to evaluate balance ability. Dartfish software was used to evaluate gait ability. The results of the study showed that Groups A and C had a significant increase in muscle strength compared with Group B; in terms of balance and gait abilities, Group C showed a significant increase in balance ability and gait speed and a significant change in knee joint angle compared with Groups A and B. In conclusion, this study suggests that including a method that applies multiple therapeutic interventions is desirable in the rehabilitation of stroke patients to improve their independence.

Keywords: overlapping effects; stroke; rehabilitation; feedback

1 Introduction

Stroke is caused either by cerebral infarction, in which a blood vessel in the brain is blocked by cerebral hemorrhage, in which blood is drained into substantial structures in the brain due to a ruptured blood vessel [1]. Stroke symptoms include not only sensory, motor, and cognitive impairments but also decreased coordination, balance, and muscle tone control. Sensory motor disorders affect muscle strength, balance, and normal gait, which increase dependence on daily living activities; thus, long-term rehabilitation is required. As dependence on daily life increases or the rehabilitation period is extended, the burden on medical expenses increases. Therefore, much attention is currently being given to rehabilitation to achieve independent walking, which plays the most critical part in reducing dependence on daily life [2,3].

Restoration of balance and gait abilities in stroke patients is considered the most basic element for improving daily living activities and enabling independent activities through functional recovery. Therefore, the common goal of rehabilitation in stroke patients with these problems is to reeducate functional performance and improve gait and balance, aiming to overcome the limit of instability to restore independence [4]. At present, the most applied general therapeutic approaches to restore balance and gait in stroke patients are functional electrical stimulation therapy, treadmill training, the Bobath approach, proprioceptive neuromuscular facilitation, the Brunnstrom approach, and stabilization exercises. These approaches are regarded as treatments that improve functional recovery based on neurophysiological theories [5,6,7].

Muscle weakness occurs after a stroke, and muscle weakness in a patient indicates severe damage. Muscle weakness after stroke may be caused by a decrease in muscle fiber size and excitation rate, atrophy of type 2 muscle fibers, increased fatigue, a decrease in the number of motor units, or changes in motor unit recruitment [8]. Clinically, muscle weakness is a factor that limits the functional rehabilitation of stroke patients, and the measurement of muscle strength is a crucial item for predicting gait ability. Given that muscle weakness decreases gait speed and endurance, which makes tools or other people’s help during walking necessary for the patient and causes difficulty in changing their posture independently, enhancing the strength of the impaired muscle is the goal of therapeutic intervention to enable the patient to perform functional movements [9].

Stroke patients experience difficulty in controlling their movements due to muscle weakness, abnormal muscle tension, and abnormal movement patterns [10]. Stroke patients tend to use only the unaffected limb rather than the paralyzed limb for an extended period; thus, they often experience muscle weakness in the upper and lower limbs on the paralyzed side [11]. Due to muscle weakness in the upper and lower extremities on the paralyzed side, approximately 61–80% of the total body weight of stroke patients is likely to shift toward the lower extremity on the unaffected side in the standing position. Consequently, they show asymmetric body balance and defects in gait, weight transfer, and voluntary movement. Furthermore, since the center of gravity of the body of stroke patients shifts to the unaffected side, symmetrical weight transfer barely occurs in response to external shaking, reducing their ability to maintain balance. Furthermore, when postural agitation occurs, abnormal muscle recruitment arises, and endurance required for weight bearing is also reduced, making it increasingly difficult for stroke patients to maintain their posture [12,13].

The main cause of the decrease in gait speed and endurance in stroke patients is muscle weakness [10]. Progressive resistance training is a training method that enhances muscle strength by gradually increasing the resistance applied to the muscle. This method is effective in strengthening muscles on both the affected and unaffected sides of stroke patients and in recovering gait function by increasing the muscle strength of the lower extremities [14]. Systematic research on these studies has demonstrated that progressive resistance training is effective in increasing muscle strength after stroke. The key elements of progressive resistance training are the supply of sufficient resistance and the application of a training program over a sufficient period (at least 4 weeks) for the gradual increase in resistance and muscle strength. In addition, various muscle strengthening programs using other clinical intervention methods, such as elastic bands, weight training equipment, and isokinetic equipment, are utilized to overcome the muscle weakness problem in stroke patients [15].

In the posture of a stroke patient, the control ability of the central nervous system plays a significant role in maintaining the center of the body within the stability limit. Stroke patients with a damaged central nervous system lose their motor control ability, which maintains their center of gravity, leading to asymmetrical weight support and consequently shifting 60–90% of their body weight toward the unaffected side [16]. This unbalanced weight shift has direct effects, such as unstable gait and reduced gait speed; it also increases the risk of falls – approximately 25% of stroke patients experience falls. Therefore, postural control that enables well-balanced body weight support on both sides is an important goal of rehabilitation training for stroke patients to secure independence in their daily lives [17].

Gait and balance abilities are measures that can determine the recovery level of stroke patients and are thus used as important indicators necessary for independent living [12,13]. Due to their decreased gait ability, stroke patients commonly show a unilateral gait pattern, asymmetric gait length, shortened single-leg support time, decreased motion of the hip and knee joints due to abnormal muscle tension, and increased plantar flexion of the foot [18]. Deterioration of balance ability in stroke patients is caused by reduced basic input sense and difficulty in integrating the input sense. In addition, stroke patients experience difficulties in maintaining balance because they lack postural stability due to their reduced motor control ability and weakened muscle strength. They also show asymmetric weight support and increased postural sway while standing due to their lost balance sense [19].

Since stroke patients have physical function impairments, they exhibit more asymmetric patterns between the paralyzed side and the unaffected side in many areas, such as stride length, step length, step speed, stance phase, and swing phase, compared with the general population at the same age [9]. Although 75% of stroke patients can walk, 50% experience walking disabilities. Gait impairment is caused by a decrease in balance ability due to reduced muscle control ability and proprioception and difficulty in weight transfer. In contrast to healthy people, stroke patients show reduced mobility and stability, reduced gait speed, increased energy inefficiency, altered gait patterns, and reduced restrictive walking endurance [20]. Stroke patients are unable to distribute their total body weight evenly over both legs. Independent gait ability is one of the most crucial factors in the quality of life and participation in daily life and is one of the most important abilities that must be improved through physical therapy to help patients return to their daily lives [21].

Various approaches have been studied to improve the gait ability of patients with post-stroke hemiplegia [13,14,22]. In addition, in stroke patients, if they walk slowly by reducing their gait speed, the one-sided leaning of the gait becomes much more severe. This is because increased gait speed activates the central tendency generator in the spinal cord or brainstem, which improves gait ability. Based on this gait control ability of the central tendency generator, treadmill exercise is used as a therapeutic intervention method for the rehabilitation of patients with damaged central nervous system [23,24].

In a comparison between gait training conducted on normal ground and gait training on a treadmill, gait training using a treadmill is more effective; thus, the importance of gait training using a treadmill is increasing [23]. Recently, gait training on a treadmill in a partial weight support condition, which is based on task-oriented training, has been reported to aid in restoring the gait ability of stroke patients through muscle strengthening, lower body stabilization, and reeducation of balance and gait pattern control. When a safety assist device is worn during gait training on a treadmill, the abnormal gait pattern is improved, and stride length and speed are increased [25]. In addition, an anti-gravity treadmill (AGT) enables weight-bearing exercise in the early stage after surgery; during the early weight-bearing exercise, the training can be performed by adjusting the patient’s weight in 1% increments/decrements and by controlling pain and adjusting exercise intensity. In addition, an advantage of this training method is that a safety device prevents falls and slips during exercise; thus, exercise can be safely performed [26].

After a stroke, many patients suffer from loss of visual information with impaired proprioception, which results in loss of visual and spatial perception [27]. Feedback training is used to improve the balance and walking ability of stroke patients. In visual feedback training, the actual movement of the subject is reflected on the screen in various forms to imitate the actual movement, informing the subject of their position in the virtual space or whether the movement was successful using visual elements. In this manner, this technique provides biofeedback for the subject’s movement toward them [28].

Although numerous studies regarding the efficient rehabilitation of stroke patients have been conducted [20], research on training methods using visual biofeedback is lacking. Most studies focusing on the fragmentary physical elements of stroke patients have been conducted. In addition, studies on the effects of rehabilitation therapy caused by overlapping treatment methods are insufficient. Therefore, this study investigated the effects of treatment methods accompanying biofeedback on muscle strength, balance, and gait ability, which are key factors that indicate the level of rehabilitation in stroke patients, using an AGT and a Biorescue system that can provide visual feedback. In addition, the overlapping effect of the two treatments that provide feedback was investigated by sequentially applying the AGT and Biorescue systems.

2 Materials and methods

2.1 Subjects

A total of 45 patients diagnosed with post-stroke hemiplegia based on magnetic resonance imaging by a rehabilitation medicine specialist at a rehabilitation hospital were included in this study as study subjects. Before participating in this study, all patients were provided with an explanation of the overall purpose, process, risks, and side effects of the study, and they then completed the informed consent form. All research procedures were performed under the supervision of the Institutional Review Board in accordance with the Declaration of Helsinki. All experimental procedures and protocols have been approved by the research ethics committee following the guidelines of the university.

2.2 Design

The study subjects were divided into Group A, which performed the AGT training with visual feedback; Group B, which trained using the Biorescue system with visual feedback; and Group C, which sequentially performed AGT training and Biorescue training to examine the overlapping effects of the treatment. A total of 15 participants were assigned to each group through randomization.

  1. The inclusion criteria for the subjects in this study were as follows: (A) Those who were diagnosed more than 6 months ago with hemiplegic stroke using a brain imaging-based specialist. (B) Those without any cognitive impairment that interfered with participation in the study, that is, those with a mini-mental state examination score of 24 points or higher. (C) Those who can walk more than 10 m independently using a walking aid or under the supervision of a therapist. (D) Those who were diagnosed with defects in balance and gait by a specialist. (E) Those without any visual impairment, problems in the cardio-respiratory system, or other neurological problems that may affect walking. (F) Those who agreed to participate in the study after being informed about the purpose and method of this study.

  2. The exclusion criteria for the subjects in this study were as follows: (A) Those with recurrent strokes. (B) Those with neurological or orthopedic disorders other than stroke. (C) Those who withdrew their intention to participate in the study.

2.3 Intervention

AGT can adjust the load applied to the knee from 20 to 90% in 1% increments/decrements, enabling walking exercises without pain. Furthermore, by connecting the patient wearing a suit exclusively designed for an AGT with the AGT, the risk of injury from losing balance and falling during exercise is minimized. Therefore, AGT is a device that enables research to be conducted safely. The exercise program used in this study was performed according to the protocol suggested by the manufacturer of Alter-G (Alter-G®; AlterG, Inc., Fremont, CA, USA) using the AGT equipment after some modifications and supplementations. It was performed three times a week for 30 min for over 2 weeks with a physical therapist with professional knowledge of neurological physical therapies and more than 10 years of experience.

In this study, for the initial treatment using the AGT exercise program, weight was reduced by up to 80%, and the speed was set to 0.5 km/h. The weight load and speed were then gradually increased. The exercise program was divided into three stages. In the first stage (weeks 1–4), the weight load was gradually increased by 1%, from 20 to 30% as the program progressed, and the speed was maintained at 0.5 km/h in all stages. In the second stage (weeks 5–8), the goal was set to 30–50%, and the weight load was increased by 1 or 2% depending on the program and progressed to 50% in the final week. In the third and final stage (weeks 5–8), the weight load was raised from 1 to 4% according to the patient’s adaptation level, so that a weight load of 80% or more was applied in the final week.

In this study, cognitive tasks and balance training were performed using the Biorescue (RM INGENIERIRE, Rodez, France) equipment. The subjects participated in the experiment while standing on a decompression platform 1.5 m away from the monitor, and they performed the tasks provided by each program by moving their bodies. Before the application of the exercise, all subjects were explained how to use the equipment and precautions. In this study, weight transfer training using trunk movements (i.e., flexion, extension, lateral flexion, and rotation), upper and lower extremity movement, and cognitive task training were performed simultaneously. In this study, both training methods were performed for 15 min each. The first training was to memorize four card pictures located in four directions (east, west, south, and north), and a card picture with the same image as in the presented card picture was searched by shifting the weight. The second training was training to find the same card picture as in the flipped card picture through a shift in weight among eight card pictures with two identical card pictures. Initially, the exercise intensity was set according to each subject, and the intensity gradually increased. Safety bars were installed on the front and sides to prevent falls during training, and a physical therapist with more than 10 years of clinical experience and 10 years of experience in instructing Biorescue training supervised and instructed the patient during the training. In addition, one assistant helped the subject with training to secure stability. Every training was applied for 30 min each time, three times a week for a total of 12 weeks.

2.4 Outcome measure

2.4.1 Muscle strength of lower extremities

In this study, lower extremity muscle strength was evaluated by measuring the muscle strength of the knee extensor and flexor on the affected side using a manual muscle strength measuring device. In this study, the pressure at the maximum isometric contraction of each muscle was measured three times, and the average value was used for the analysis. Knee joint extension and flexion were measured in a sitting position. To measure the knee joint extensor muscle, we instructed the subject to straighten the knee with a pressure plate of the manual muscle strength measuring device placed on the front side of the ankle. To measure the knee joint flexor muscle, we instructed the subject to bend the knee with a pressure plate placed on the heel.

2.4.2 Static and dynamic balance

Timed Up and Go (TUG) test: The TUG is used to measure mobility, dynamic balance, and moving ability and is particularly useful for evaluating gait and the ability to perform the task of turning around obstacles and then returning to the starting point. This method measures the time it takes for a round trip, starting from sitting on a chair that is 50 cm high, going around the turning point that is 3 m away, and returning and sitting back on the chair. This test is an evaluation tool developed to examine functional mobility. It is an easy, simple, and fast test method that can be performed rapidly because mobility can be quantified; thus, it is currently widely used in clinical practice. It is also an evaluation method that can predict the risk of falls by assessing the ability to maintain balance while walking in a short time. If the result of TUG is less than 10 s, no problem with gait ability is considered; if the result is from 11 to 20 s, a problem with gait ability is considered; if it takes more than 20 s, functional motor impairment is considered. In this study, the subjects were allowed to make one round trip, and the time to take the next three round trips was then measured. The average time was recorded as the measurement for the analysis.

The Bug Balance Scale (BBS) is a tool designed to evaluate balance ability. Currently, it is widely used clinically to determine the degree of functional performance about balance in stroke patients and has the advantage of easy evaluation, regardless of location. The BBS is a tool used to measure functional standing balance, consisting of a total of 14 items in three areas: sitting, standing posture, and postural change. It has a total of 14 items on a 5-point scale, from a minimum of 0 to a maximum of 4 points, with a total of 56 points. The higher the score, the better the state of balance ability. In general, 0–20 points indicate a need to use a wheelchair, and 21–40 points indicate a need for walking with an aid or assistance. For complete independent walking, 41 points or higher are required, and 45 points or higher are required for independent and safe movement. Recently, BBS has also been used to evaluate the balance ability of patients with stroke, cerebral palsy, and Parkinson’s disease.

2.4.3 Gait ability

This study analyzed the patient’s gait using the Dartfish Express PC version 10.0 (DFKOREA, Korea). Dartfish is a software that can analyze and interpret motions by taking videos using a camera; it is widely used in the field of rehabilitation. In this study, to measure and compare the changes in the time point at which the knee angle becomes the greatest in the swing phase during walking, we fixed the camera 3 m away from the 10 m path, where the subject walks on a flat surface in the laboratory. The anatomical locations, such as the greater trochanter of the femur, the lateral epicondyle of the femur, and the lateral malleolus, were attached with 3 cm markers. When the subject was walking, the angle at which the extension lines connected with each marker met was measured, and the angle of the knee joint during the mid-swing phase was recorded and then measured using the Dartfish software program for motion analysis. This procedure was repeated three times. The average value was then used for the analysis.

2.5 Statistical analysis

In this study, IBM SPSS Statistics 20.0 was used for statistical processing. The mean and standard deviation of each variable, which was measured to evaluate muscle strength, balance, and gait, were calculated through descriptive statistics, and their normality was examined through the Kolmogorov–Smirnov test. A paired-sample t-test was used to compare the within-group differences between the before and after training for muscle strength, balance, and gait. An analysis of variance was performed to compare the difference in treatment effects between groups, and LSD was used as a post hoc test. The statistical significance level (α) was set to 0.05 or less.

3 Results

The study subjects’ general characteristics and pre-test assessments, including knee extensor, knee flexor, TUG, BBS, and knee joint angle, were homogenous with no statistically significant differences (Table 1).

Table 1

General characteristics of subjects and homogeneity test of pre-test assessments

Group A Group B Group C P
Age (years) 65.84 ± 4.22 67.09 ± 6.13 66.54 ± 5.08 0.512
Weight (kg) 56.18 ± 6.81 53.63 ± 5.08 57.34 ± 6.42 0.264
Knee extensor (kg) 8.15 ± 2.95 7.64 ± 3.78 8.22 ± 3.05 0.763
Knee flexor (kg) 4.11 ± 1.87 4.98 ± 2.14 3.98 ± 1.57 0.864
TUG (s) 30.48 ± 9.56 28.46 ± 10.68 27.67 ± 9.37 0.184
BBS (score) 28.64 ± 5.69 27.61 ± 4.55 30.14 ± 7.01 0.149
Knee joint (angle) 30.15 ± 8.31 28.14 ± 8.21 31.88 ± 9.17 0.138

Group A, anti-gravity treadmill training group provided with visual feedback; Group B, Biorescue training group provided with visual feedback; Group C, anti-gravity treadmill training + Biorescue training group provided with visual feedback; TUG: Timed Up and Go; BBS: Bug Balance Scale.

In the comparison of the within-group differences between the before and after training for knee extensor muscle strength, a statistically significant increase in muscle strength was observed in Group A with AGT training and Group C with AGT training, followed by Biorescue training (Table 2). A significant difference was found in the analysis of variance, which was conducted to determine the difference in the treatment effect between groups; thus, a post hoc test was performed. Groups A and C showed a greater increase in extensor muscle strength than Group B, and no statistically significant difference was observed in the amount of increase between Groups A and C.

Table 2

Comparison of muscle strength of the knee extensors on the paretic side

Extensors Group A Group B Group C f P
Pre-test 8.15 ± 2.95 7.64 ± 3.78 8.22 ± 3.05 0.619 0.763
Post-test 11.37 ± 3.67 8.95 ± 2.64 13.46 ± 4.12 4.684 0.000*
t −2.05 −0.98 −4.57
P 0.024* 0.059 0.000*

Group A, anti-gravity treadmill training group provided with visual feedback; Group B, Biorescue training group provided with visual feedback; Group C, anti-gravity treadmill training + Biorescue training group provided with visual feedback; unit, ㎏; *P < 0.05.

Likewise, in the comparison of the within-group differences between the before and after training for the knee flexor, a statistically significant increase in muscle strength was observed in Group A with AGT training and Group C with AGT training, followed by Biorescue training. Group B showed an increase in the mean value; however, it was not statistically significant (Table 3). A significant difference was found in the analysis of variance, which was conducted to determine the inter-group difference in the treatment effect; thus, a post hoc test was performed. Groups A and C showed a greater increase in flexor muscle strength than Group B, and no statistically significant difference was observed between Groups A and C.

Table 3

Comparison of muscle strength of the knee flexors on the paretic side

Flexors Group A Group B Group C f P
Pre-test 4.11 ± 1.87 4.98 ± 2.14 3.98 ± 1.57 0.538 0.864
Post-test 6.78 ± 2.06 5.39 ± 1.98 7.44 ± 2.24 3.612 0.048*
t −0.26 −0.53 −3.87
P 0.018* 0.071 0.008*

Group A, anti-gravity treadmill training group provided with visual feedback; Group B, Biorescue training group provided with visual feedback; Group C, anti-gravity treadmill training + Biorescue training group provided with visual feedback; unit, ㎏; *P < 0.05.

In the comparison of the within-group differences between the before and after training for TUG, a statistically significant increase in gait speed in all three groups was found: Group A with AGT training, Group B with Biorescue training, and Group C with AGT training, followed by Biorescue training (Table 4). A significant difference was found in the analysis of variance, which was conducted to determine the inter-group difference in the treatment effect; thus, a post hoc test was performed. Groups A and C showed a greater increase in gait speed than Group B, and Group C showed a statistically significant difference in the increase in gait speed compared with Group A.

Table 4

Comparison of Timed Up and Go test

TUG Group A Group B Group C f P
Pre-test 30.48 ± 9.56 28.46 ± 10.68 27.67 ± 9.37 2.267 0.184
Post-test 26.68 ± 10.25 26.55 ± 9.27 21.82 ± 8.95 5.591 0.000*
t 3.71 1.96 5.33
P 0.000* 0.027* 0.000*

Group A, anti-gravity treadmill training group provided with visual feedback; Group B, Biorescue training group provided with visual feedback; Group C, anti-gravity treadmill training + Biorescue training group provided with visual feedback; unit, seconds; *P < 0.05.

In the comparison of the within-group differences between the before and after training for BBS, a statistically significant increase in the BBS score was observed in Group A with AGT training and Group C with AGT training, followed by Biorescue training. Group B showed an increase in the mean value; however, it was not statistically significant (Table 5). A significant difference was found in the analysis of variance, which was conducted to determine the inter-group difference in the treatment effect; thus, a post hoc test was performed. Groups A and C showed a greater increase in the BBS score than Group B, and Group C showed a statistically significant difference in the amount of increase compared with Group A.

Table 5

Comparison of BBS

BBS Group A Group B Group C f P
Pre-test 28.64 ± 5.69 27.61 ± 4.55 30.14 ± 7.01 2.687 0.149
Post-test 32.36 ± 6.37 29.45 ± 6.87 36.43 ± 5.23 5.132 0.000*
T −4.03 −1.08 −6.12
P 0.000* 0.053 0.000*

Group A, anti-gravity treadmill training group provided with visual feedback; Group B, Biorescue training group provided with visual feedback; Group C, anti-gravity treadmill training + Biorescue training group provided with visual feedback; unit, score; *P < 0.05.

In the comparison of the within-group differences between the before and after training for the change in knee angle during walking, a statistically significant change was observed in the knee angle in all three groups: Group A with AGT training, Group B with Biorescue training, and Group C with AGT training, followed by Biorescue training (Table 6). A significant difference was found in the analysis of variance, which was conducted to determine the inter-group difference in the treatment effect; thus, a post hoc test was performed. Groups A and C showed a greater change in knee angle during walking than Group B, and Group C showed a statistically significant change in knee angle compared with Group A.

Table 6

Comparison of the angle of the knee joint

Knee angle Group A Group B Group C f P
Pre-test 30.15 ± 8.31 28.14 ± 8.21 31.88 ± 9.17 2.857 0.138
Post-test 33.67 ± 9.03 29.66 ± 7.66 37.54 ± 8.34 5.984 0.000*
t −3.78 −1.35 −6.03
P 0.000* 0.041* 0.000*

Group A, anti-gravity treadmill training group provided with visual feedback; Group B, Biorescue training group provided with visual feedback; Group C, anti-gravity treadmill training + Biorescue training group provided with visual feedback; unit, angle; *P < 0.05.

4 Discussion

Neuroplasticity is a phenomenon in which the brain nerves change and reorganize their structures and functions by learning from the experience of external stimuli, and it occurs continuously throughout life. During periods of vigorous learning of other languages or motor skills, such as during childhood, the activity of new neural pathways is maximized [29]. Although the potential decreases in adulthood or old age, a certain level of neuroplasticity is maintained throughout life. The brain is composed of nerve cells (neurons) and glial cells that are connected. Learning can occur through changes in the length of nerve cell connections, the addition or removal of connections, and the formation of new nerve cells, and neuroplasticity is related to such a learning process [30].

Neuroplasticity, the process by which the human brain changes according to experience also refers to the ability of the brain to reorganize or rearrange after damage to the central nervous system. It can be considered an adaptation process of the nervous system in which the function and shape of the cerebral cortex change to suit the surrounding environment or lesion [31]. Brain plasticity plays a significant role in the recovery of cerebral functions, such as learning and memory, after a brain lesion occurs. Plastic changes mainly occur in synapses widely distributed in the cerebrum, through which the network in the brain is reorganized [32]. In addition, recent studies have emphasized the importance of afferent sensory information in the coordination between limbs. As reported, the integration of sensory movements that occur between the left and right cerebral hemispheres is a crucial factor in the recovery of motor functions after stroke, and the rehabilitation strategy that induces active use of sensory feedback is effective. When such sensory information is transmitted to the sensory center area, it can be involved in the control of voluntary movements related to the main motor area adjacent to the sensory center area, which supports the effectiveness of rehabilitation treatment using various sensory stimuli [33,34]. In summary, the learning of new motor skills by the normal central nervous system and the reacquisition of functional activity after a brain injury are similar in many aspects. The biomechanical changes that occur when skills are reacquired after a stroke in the motor performance stage are similar to those that occur when people without a lesion learn new skills [35].

Stroke-related hemiplegia patients have a decreased sensation in each part of the body on the paralyzed side, with lowered abilities to move their limbs and interact with the environment due to the decrease in proprioception, which plays a key role in postural sway control in various environments [12]. In terms of proprioception, action potentials generated from proprioceptive sensory receptors, such as muscles, joints, and tendons, act afferently, which makes the nerve center sense and feel the body’s movement and positional sense, thereby enabling the body to control balance and posture automatically according to changes in various external environments and situations. Proprioception is a sense that includes a positional sense that informs the position of each joint and a motor sense that detects the degree and speed of muscle movement. Motor sense refers to the ability to perceive the direction of movement and responses [28,36].

As a crucial factor in the performance of functional activities, proprioceptive sense has a significant correlation with the ability to maintain posture; thus, it is used as a predictor of various injuries [37]. It also can recognize joint angles using the positional sense, which provides the central nervous system with information on the recognition of body position and posture, the angles and angular velocity of all joints involved in the movement in each movement plane, and the ratio of their movements. This sense plays the most important role in maintaining dynamic joint stability, inducing normal movement, and safely protecting joints from external damage [38]. In addition, the sense of movement or position of joints is affected by various types of senses, including visual and skin senses; loss of positional sense leads to lowered motor performance and difficulties in performing activities in daily life. Therefore, proprioception is a conscious sense of joint motion and position, and it has been used as an important factor in observing the prognosis for the rehabilitation of a patient [39].

Stroke patients experience a lot of difficulties in walking due to the impairment of proprioception that occurs after damage to the central nervous system. Most stroke patients experience difficulties in walking because of the ground environment or exposed locational factors due to not only muscle weakness, abnormal muscle movement, stiffness, and decreased balance ability but also decreased proprioception that interferes with normal walking [9,12]. Disabilities appear in the legs due to neurological damage, and these disabilities can cause asymmetric gait and lowered balance ability. In addition, as a result of asymmetric gait, abnormal gait patterns, such as slow gait speed, the occurrence of instability during gait, differences in stride length during gait, short stance phase on the paralyzed side, and relatively long swing phase, appear [40]. For stroke patients, a lack of walking ability is considered the main cause that limits their daily living activities in the early stages after the onset of the disease.

Balance is the ability to control the position of joints or muscle activity to maintain body weight on the supporting ground, and postural stability means not losing balance while standing or not falling while performing dynamic activities [4]. Balance can also be divided into static balance and dynamic balance. Static balance refers to the ability to stand on a fixed support surface without shaking, and dynamic balance refers to balance while moving on a support surface, with an external stimulus or while moving unaided [16]. Balance disorders that occur after stroke appear due to changes in the motor control sense and the integration thereof. Balance ability-related problems occur in the sub-acute phase after the first onset of stroke, and trunk damage, balance limitations, and postural control disorders increase the risk of falls and cause gait disturbances in stroke patients. These problems increase the dependence of stroke patients on activities in daily life and reduce their quality of life [41].

Re-establishing the balance function of patients with stroke-related hemiplegia through rehabilitation treatment is an important goal of rehabilitation, and several balance training methods using visual feedback have been studied to improve balance control ability. Providing stroke patients with far more feedback for motor learning than normal people is necessary, and balance retraining of stroke patients using visual feedback improves their balance control ability considerably when feedback is provided. In addition, through visual feedback training, patients can check their positional and postural changes in real time; the patients themselves recognize the postural information and use it to control and maintain their postures [42,43]. A high level of motivation can have a positive effect on the outcomes of rehabilitation training. In this study, visual feedback was provided to all groups to improve balance ability, and improvements in balance ability were observed in the results of the TUG and BBS. Furthermore, a statistically significant increase was observed in balance ability and gait speed in Group C, which received both AGT training and Biorescue training, compared with the other groups. This result can be attributed to the fact that the lower extremity muscle strengthening effect of AGT and the improvement of dynamic and static balance ability through Biorescue training overlapped, creating a remarkable effect.

Stroke patients tend to use only the unaffected limb rather than the paralyzed limb for a long period, which results in muscle weakness in the paralyzed limb. Due to muscle weakness in the lower extremity on the paralyzed side, approximately 60% or more of the total body weight shifts toward the lower extremity on the unaffected side in the standing position. Consequently, stroke patients show asymmetric body balance and defects in gait, weight transfer, and voluntary movement [44,45]. Especially since the center of gravity of the body shifts to the unaffected side in stroke patients, symmetrical weight shift does not occur in response to sudden external disturbances, which reduces their ability to maintain balance and causes abnormal muscle recruitment, making it difficult for them to maintain posture [41].

Muscle weakness is the main cause of a decrease in gait speed in stroke patients; thus, studies on eccentric training have been conducted to find a way to improve muscle strength. Progressive resistance training is a training method that enhances muscle strength by gradually increasing the resistance applied to the muscle. This method is effective in strengthening the muscles on both the affected and unaffected sides of stroke patients [46]. Systematic research on these studies has demonstrated that resistance training is effective in strengthening muscles after stroke. The key elements of progressive resistance training are the supply of sufficient resistance and the application of a training program over a sufficient period (at least 4 weeks) for the gradual increase in resistance and the increase in muscle strength [47]. In this study, an AGT treatment device was used in Groups A and C for progressive resistance training. The extensor and flexor muscles of the knee are important muscles that provide stability and mobility of the knee during walking. In this study, a statistically significant increase in these two muscles was observed in the groups using AGT. This result suggests that the patient’s lower extremity muscle strength increased because the AGT was able to assist the patient in walking repeatedly for 12 days. In addition, this increase in the muscle strength of the lower extremity is likely related to the increase in proprioceptive activity because visual feedback was applied during the AGT training.

The characteristic gait patterns of stroke patients include that while walking, the tip of the toe touches the ground before the heel touches it during the stance phase of the paralyzed side and that the swing phase of the paralyzed side is longer than that of the unaffected side, resulting in asymmetry during walking. Furthermore, compared with the non-paralyzed side, the paralyzed side requires more time for the swing phase during toe-off according to the decrease in the angle change in the knee joint [9,14]. The stance phase of both legs increases, whereas the gait speed and propulsive force decrease, and footdrop and varus are observed in the stance phase on the paralyzed side. This asymmetrical gait decreases gait speed, gait endurance, and balance ability, which limits the independent movement ability of stroke patients. In other words, restoration of gait ability in stroke patients is the goal of rehabilitation that should be considered first to enable them to perform daily living activities independently [16,18].

Compared with healthy people, stroke patients’ activity of the extensor muscle of the knee joint is abnormally higher due to a synergistic pattern over time. This elevated extensor muscle activity is an element necessary for walking; however, excessive extensor muscle activity results in limiting the flexion angle of the knee joint in the swing phase, inducing abnormal compensatory action [48]. Circumduction gait, which is a typical compensatory action, involves walking in a circular motion using the pelvis and hip joint during walking. This causes numerous problems, such as a reduction in gait speed, asymmetrical stride length and time for the stance and swing phases, reduction in the efficiency of muscle activity, and increased energy consumption [49]. In this study, gait was analyzed using the Dartfish program to determine the change in knee flexion angle during walking according to therapeutic interventions. The results of this study showed a statistically significant increase in knee joint angle in all groups in which visual feedback was applied. This result can be attributed to the fact that the sensory information received by the patient through the application of visual feedback during walking continuously stimulated the motor integration center of the brain, followed by the recorrection process, and movement control then occurred. In addition, in Group C, in which both the treadmill training and the Biorescue training that provided visual feedback were applied, a statistically significant flexion of the knee joint was observed compared with the other groups. This result can be attributed to the overlapping effect of the two treatments focusing on visual feedback, muscle strength, and balance ability.

To secure the independence of patients after a stroke, we should apply a treatment method that can simultaneously improve numerous factors, such as proprioception, muscle strength, balance ability, and gait ability, rather than a fragmentary treatment method [20,23]. The findings of this study also showed that new motor control and motor integration can be induced in patients rapidly and easily by applying visual feedback simultaneously during therapeutic interventions. However, this study has limitations: it failed to examine the lasting effect of the treatment since the treatment interventions were applied only for a short period, and it was difficult to generalize the findings of this study because of the small sample size used in this study. Considering that only two fragmentary evaluations were conducted in this study, a further study based on the design and results of this study must be conducted in the future, so that the pattern and duration of the treatment effect and the duration of the overlapping effect can be assessed through continuous application of treatment for more than 6 months and quantitative evaluation every 2 weeks.

  1. Funding information: This research was supported by Kyungdong University Research Fund, 2023.

  2. Author contributions: Jung-Ho Lee conceived and designed the experiments; Jung-Ho Lee and Dae-Hwan Lee collected clinical data from all participants; Jung-Ho Lee and Dae-Hwan Lee analyzed and interpreted the data; Jung-Ho Lee wrote the manuscript; Jung-Ho Lee and Dae-Hwan Lee revised the manuscript. All authors read and approved the final manuscript.

  3. Conflict of interest: Author Jung-Ho Lee is an Editor in OM Journal, but it did not affected the peer-review process. The authors declare that they have no other competing interest.

  4. Data availability statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Received: 2022-12-09
Revised: 2023-08-04
Accepted: 2023-10-04
Published Online: 2023-10-27

© 2023 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
  93. Nrf2 protects against myocardial ischemia-reperfusion injury in diabetic rats by inhibiting Drp1-mediated mitochondrial fission
  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
  95. Bladder cancer screening: The new selection and prediction model
  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
  97. Prone position effect in intensive care patients with SARS-COV-2 pneumonia
  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
  101. Low Ang-(1–7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19
  102. Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study
  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
  104. Clinical significance of serum MBD3 detection in girls with central precocious puberty
  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
  106. Collagen treatment of complex anorectal fistula: 3 years follow-up
  107. LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through down-regulating SP-A by sponging to miR-424
  108. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen – An open-label, randomized trial
  109. SMOC2 plays a role in heart failure via regulating TGF-β1/Smad3 pathway-mediated autophagy
  110. A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults
  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
  112. hsa_circ_0000285 sponging miR-582-3p promotes neuroblastoma progression by regulating the Wnt/β-catenin signaling pathway
  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
  115. Twenty-four-color full spectrum flow cytometry panel for minimal residual disease detection in acute myeloid leukemia
  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
  117. Anti-inflammatory effect of ApoE23 on Salmonella typhimurium-induced sepsis in mice
  118. Analysis of somatic mutations and key driving factors of cervical cancer progression
  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
  121. Effects of pharmacological delay with roxadustat on multi-territory perforator flap survival in rats
  122. Analysis of heroin effects on calcium channels in rat cardiomyocytes based on transcriptomics and metabolomics
  123. Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study
  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
  126. Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer
  127. The protective effect of caffeic acid phenethyl ester in the nephrotoxicity induced by α-cypermethrin
  128. Norepinephrine alleviates cyclosporin A-induced nephrotoxicity by enhancing the expression of SFRP1
  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
  136. Clinical characteristics of current COVID-19 rehabilitation outpatients in China
  137. Luteolin alleviates ulcerative colitis in rats via regulating immune response, oxidative stress, and metabolic profiling
  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
  139. The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial
  140. Elevated blood acetoacetate levels reduce major adverse cardiac and cerebrovascular events risk in acute myocardial infarction
  141. The effects of progesterone on the healing of obstetric anal sphincter damage in female rats
  142. Identification of cuproptosis-related genes for predicting the development of prostate cancer
  143. Lumican silencing ameliorates β-glycerophosphate-mediated vascular smooth muscle cell calcification by attenuating the inhibition of APOB on KIF2C activity
  144. Targeting PTBP1 blocks glutamine metabolism to improve the cisplatin sensitivity of hepatocarcinoma cells through modulating the mRNA stability of glutaminase
  145. A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
  146. Clinical analysis of AN69ST membrane continuous venous hemofiltration in the treatment of severe sepsis
  147. Antibiotics therapy combined with probiotics administered intravaginally for the treatment of bacterial vaginosis: A systematic review and meta-analysis
  148. Construction of a ceRNA network to reveal a vascular invasion associated prognostic model in hepatocellular carcinoma
  149. A pan-cancer analysis of STAT3 expression and genetic alterations in human tumors
  150. A prognostic signature based on seven T-cell-related cell clustering genes in bladder urothelial carcinoma
  151. Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter
  152. The antihypertensive felodipine shows synergistic activity with immune checkpoint blockade and inhibits tumor growth via NFAT1 in LUSC
  153. Tanshinone IIA attenuates valvular interstitial cells’ calcification induced by oxidized low density lipoprotein via reducing endoplasmic reticulum stress
  154. AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy
  155. Establishment of two oxaliplatin-resistant gallbladder cancer cell lines and comprehensive analysis of dysregulated genes
  156. Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis
  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
https://doi.org/10.1515/med-2023-0828
Keywords for this article
overlapping effects; stroke; rehabilitation; feedback
Creative Commons
BY 4.0

Articles in the same Issue

  1. Research Articles
  2. Exosomes derived from mesenchymal stem cells overexpressing miR-210 inhibits neuronal inflammation and contribute to neurite outgrowth through modulating microglia polarization
  3. Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia
  4. circ-IARS depletion inhibits the progression of non-small-cell lung cancer by circ-IARS/miR-1252-5p/HDGF ceRNA pathway
  5. circRNA ITGA7 restrains growth and enhances radiosensitivity by up-regulating SMAD4 in colorectal carcinoma
  6. WDR79 promotes aerobic glycolysis of pancreatic ductal adenocarcinoma (PDAC) by the suppression of SIRT4
  7. Up-regulation of collagen type V alpha 2 (COL5A2) promotes malignant phenotypes in gastric cancer cell via inducing epithelial–mesenchymal transition (EMT)
  8. Inhibition of TERC inhibits neural apoptosis and inflammation in spinal cord injury through Akt activation and p-38 inhibition via the miR-34a-5p/XBP-1 axis
  9. 3D-printed polyether-ether-ketone/n-TiO2 composite enhances the cytocompatibility and osteogenic differentiation of MC3T3-E1 cells by downregulating miR-154-5p
  10. Propofol-mediated circ_0000735 downregulation restrains tumor growth by decreasing integrin-β1 expression in non-small cell lung cancer
  11. PVT1/miR-16/CCND1 axis regulates gastric cancer progression
  12. Silencing of circ_002136 sensitizes gastric cancer to paclitaxel by targeting the miR-16-5p/HMGA1 axis
  13. Short-term outcomes after simultaneous gastrectomy plus cholecystectomy in gastric cancer: A pooling up analysis
  14. SCARA5 inhibits oral squamous cell carcinoma via inactivating the STAT3 and PI3K/AKT signaling pathways
  15. Molecular mechanism by which the Notch signaling pathway regulates autophagy in a rat model of pulmonary fibrosis in pigeon breeder’s lung
  16. lncRNA TPT1-AS1 promotes cell migration and invasion in esophageal squamous-cell carcinomas by regulating the miR-26a/HMGA1 axis
  17. SIRT1/APE1 promotes the viability of gastric cancer cells by inhibiting p53 to suppress ferroptosis
  18. Glycoprotein non-metastatic melanoma B interacts with epidermal growth factor receptor to regulate neural stem cell survival and differentiation
  19. Treatments for brain metastases from EGFR/ALK-negative/unselected NSCLC: A network meta-analysis
  20. Association of osteoporosis and skeletal muscle loss with serum type I collagen carboxyl-terminal peptide β glypeptide: A cross-sectional study in elder Chinese population
  21. circ_0000376 knockdown suppresses non-small cell lung cancer cell tumor properties by the miR-545-3p/PDPK1 pathway
  22. Delivery in a vertical birth chair supported by freedom of movement during labor: A randomized control trial
  23. UBE2J1 knockdown promotes cell apoptosis in endometrial cancer via regulating PI3K/AKT and MDM2/p53 signaling
  24. Metabolic resuscitation therapy in critically ill patients with sepsis and septic shock: A pilot prospective randomized controlled trial
  25. Lycopene ameliorates locomotor activity and urinary frequency induced by pelvic venous congestion in rats
  26. UHRF1-induced connexin26 methylation is involved in hearing damage triggered by intermittent hypoxia in neonatal rats
  27. LINC00511 promotes melanoma progression by targeting miR-610/NUCB2
  28. Ultra-high-performance liquid chromatography-tandem mass spectrometry analysis of serum metabolomic characteristics in people with different vitamin D levels
  29. Role of Jumonji domain-containing protein D3 and its inhibitor GSK-J4 in Hashimoto’s thyroiditis
  30. circ_0014736 induces GPR4 to regulate the biological behaviors of human placental trophoblast cells through miR-942-5p in preeclampsia
  31. Monitoring of sirolimus in the whole blood samples from pediatric patients with lymphatic anomalies
  32. Effects of osteogenic growth peptide C-terminal pentapeptide and its analogue on bone remodeling in an osteoporosis rat model
  33. A novel autophagy-related long non-coding RNAs signature predicting progression-free interval and I-131 therapy benefits in papillary thyroid carcinoma
  34. WGCNA-based identification of potential targets and pathways in response to treatment in locally advanced breast cancer patients
  35. Radiomics model using preoperative computed tomography angiography images to differentiate new from old emboli of acute lower limb arterial embolism
  36. Dysregulated lncRNAs are involved in the progress of myocardial infarction by constructing regulatory networks
  37. Single-arm trial to evaluate the efficacy and safety of baclofen in treatment of intractable hiccup caused by malignant tumor chemotherapy
  38. Genetic polymorphisms of MRPS30-DT and NINJ2 may influence lung cancer risk
  39. Efficacy of immune checkpoint inhibitors in patients with KRAS-mutant advanced non-small cell lung cancer: A retrospective analysis
  40. Pyroptosis-based risk score predicts prognosis and drug sensitivity in lung adenocarcinoma
  41. Upregulation of lncRNA LANCL1-AS1 inhibits the progression of non-small-cell lung cancer via the miR-3680-3p/GMFG axis
  42. CircRANBP17 modulated KDM1A to regulate neuroblastoma progression by sponging miR-27b-3p
  43. Exosomal miR-93-5p regulated the progression of osteoarthritis by targeting ADAMTS9
  44. Downregulation of RBM17 enhances cisplatin sensitivity and inhibits cell invasion in human hypopharyngeal cancer cells
  45. HDAC5-mediated PRAME regulates the proliferation, migration, invasion, and EMT of laryngeal squamous cell carcinoma via the PI3K/AKT/mTOR signaling pathway
  46. The association between sleep duration, quality, and nonalcoholic fatty liver disease: A cross-sectional study
  47. Myostatin silencing inhibits podocyte apoptosis in membranous nephropathy through Smad3/PKA/NOX4 signaling pathway
  48. A novel long noncoding RNA AC125257.1 facilitates colorectal cancer progression by targeting miR-133a-3p/CASC5 axis
  49. Impact of omicron wave and associated control measures in Shanghai on health management and psychosocial well-being of patients with chronic conditions
  50. Clinicopathological characteristics and prognosis of young patients aged ≤45 years old with non-small cell lung cancer
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  52. The dose limits of teeth protection for patients with nasopharyngeal carcinoma undergoing radiotherapy based on the early oral health-related quality of life
  53. miR-30b-5p targeting GRIN2A inhibits hippocampal damage in epilepsy
  54. Long non-coding RNA AL137789.1 promoted malignant biological behaviors and immune escape of pancreatic carcinoma cells
  55. IRF6 and FGF1 polymorphisms in non-syndromic cleft lip with or without cleft palate in the Polish population
  56. Comprehensive analysis of the role of SFXN family in breast cancer
  57. Efficacy of bronchoscopic intratumoral injection of endostar and cisplatin in lung squamous cell carcinoma patients underwent conventional chemoradiotherapy
  58. Silencing of long noncoding RNA MIAT inhibits the viability and proliferation of breast cancer cells by promoting miR-378a-5p expression
  59. AG1024, an IGF-1 receptor inhibitor, ameliorates renal injury in rats with diabetic nephropathy via the SOCS/JAK2/STAT pathway
  60. Downregulation of KIAA1199 alleviated the activation, proliferation, and migration of hepatic stellate cells by the inhibition of epithelial–mesenchymal transition
  61. Exendin-4 regulates the MAPK and WNT signaling pathways to alleviate the osteogenic inhibition of periodontal ligament stem cells in a high glucose environment
  62. Inhibition of glycolysis represses the growth and alleviates the endoplasmic reticulum stress of breast cancer cells by regulating TMTC3
  63. The function of lncRNA EMX2OS/miR-653-5p and its regulatory mechanism in lung adenocarcinoma
  64. Tectorigenin alleviates the apoptosis and inflammation in spinal cord injury cell model through inhibiting insulin-like growth factor-binding protein 6
  65. Ultrasound examination supporting CT or MRI in the evaluation of cervical lymphadenopathy in patients with irradiation-treated head and neck cancer
  66. F-box and WD repeat domain containing 7 inhibits the activation of hepatic stellate cells by degrading delta-like ligand 1 to block Notch signaling pathway
  67. Knockdown of circ_0005615 enhances the radiosensitivity of colorectal cancer by regulating the miR-665/NOTCH1 axis
  68. Long noncoding RNA Mhrt alleviates angiotensin II-induced cardiac hypertrophy phenotypes by mediating the miR-765/Wnt family member 7B pathway
  69. Effect of miR-499-5p/SOX6 axis on atrial fibrosis in rats with atrial fibrillation
  70. Cholesterol induces inflammation and reduces glucose utilization
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  72. NECAB3 promotes the migration and invasion of liver cancer cells through HIF-1α/RIT1 signaling pathway
  73. The poor performance of cardiovascular risk scores in identifying patients with idiopathic inflammatory myopathies at high cardiovascular risk
  74. miR-2053 inhibits the growth of ovarian cancer cells by downregulating SOX4
  75. Nucleophosmin 1 associating with engulfment and cell motility protein 1 regulates hepatocellular carcinoma cell chemotaxis and metastasis
  76. α-Hederin regulates macrophage polarization to relieve sepsis-induced lung and liver injuries in mice
  77. Changes of microbiota level in urinary tract infections: A meta-analysis
  78. Identification of key enzalutamide-resistance-related genes in castration-resistant prostate cancer and verification of RAD51 functions
  79. Falls during oxaliplatin-based chemotherapy for gastrointestinal malignancies – (lessons learned from) a prospective study
  80. Outcomes of low-risk birth care during the Covid-19 pandemic: A cohort study from a tertiary care center in Lithuania
  81. Vitamin D protects intestines from liver cirrhosis-induced inflammation and oxidative stress by inhibiting the TLR4/MyD88/NF-κB signaling pathway
  82. Integrated transcriptome analysis identifies APPL1/RPS6KB2/GALK1 as immune-related metastasis factors in breast cancer
  83. Genomic analysis of immunogenic cell death-related subtypes for predicting prognosis and immunotherapy outcomes in glioblastoma multiforme
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  88. PTPN12 down-regulated by miR-146b-3p gene affects the malignant progression of laryngeal squamous cell carcinoma
  89. miR-141-3p accelerates ovarian cancer progression and promotes M2-like macrophage polarization by targeting the Keap1-Nrf2 pathway
  90. lncRNA OIP5-AS1 attenuates the osteoarthritis progression in IL-1β-stimulated chondrocytes
  91. Overexpression of LINC00607 inhibits cell growth and aggressiveness by regulating the miR-1289/EFNA5 axis in non-small-cell lung cancer
  92. Subjective well-being in informal caregivers during the COVID-19 pandemic
  93. Nrf2 protects against myocardial ischemia-reperfusion injury in diabetic rats by inhibiting Drp1-mediated mitochondrial fission
  94. Unfolded protein response inhibits KAT2B/MLKL-mediated necroptosis of hepatocytes by promoting BMI1 level to ubiquitinate KAT2B
  95. Bladder cancer screening: The new selection and prediction model
  96. circNFATC3 facilitated the progression of oral squamous cell carcinoma via the miR-520h/LDHA axis
  97. Prone position effect in intensive care patients with SARS-COV-2 pneumonia
  98. Clinical observation on the efficacy of Tongdu Tuina manipulation in the treatment of primary enuresis in children
  99. Dihydroartemisinin ameliorates cerebral I/R injury in rats via regulating VWF and autophagy-mediated SIRT1/FOXO1 pathway
  100. Knockdown of circ_0113656 assuages oxidized low-density lipoprotein-induced vascular smooth muscle cell injury through the miR-188-3p/IGF2 pathway
  101. Low Ang-(1–7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19
  102. Effect of maternal age and body mass index on induction of labor with oral misoprostol for premature rupture of membrane at term: A retrospective cross-sectional study
  103. Potential protective effects of Huanglian Jiedu Decoction against COVID-19-associated acute kidney injury: A network-based pharmacological and molecular docking study
  104. Clinical significance of serum MBD3 detection in girls with central precocious puberty
  105. Clinical features of varicella-zoster virus caused neurological diseases detected by metagenomic next-generation sequencing
  106. Collagen treatment of complex anorectal fistula: 3 years follow-up
  107. LncRNA CASC15 inhibition relieves renal fibrosis in diabetic nephropathy through down-regulating SP-A by sponging to miR-424
  108. Efficacy analysis of empirical bismuth quadruple therapy, high-dose dual therapy, and resistance gene-based triple therapy as a first-line Helicobacter pylori eradication regimen – An open-label, randomized trial
  109. SMOC2 plays a role in heart failure via regulating TGF-β1/Smad3 pathway-mediated autophagy
  110. A prospective cohort study of the impact of chronic disease on fall injuries in middle-aged and older adults
  111. circRNA THBS1 silencing inhibits the malignant biological behavior of cervical cancer cells via the regulation of miR-543/HMGB2 axis
  112. hsa_circ_0000285 sponging miR-582-3p promotes neuroblastoma progression by regulating the Wnt/β-catenin signaling pathway
  113. Long non-coding RNA GNAS-AS1 knockdown inhibits proliferation and epithelial–mesenchymal transition of lung adenocarcinoma cells via the microRNA-433-3p/Rab3A axis
  114. lncRNA UCA1 regulates miR-132/Lrrfip1 axis to promote vascular smooth muscle cell proliferation
  115. Twenty-four-color full spectrum flow cytometry panel for minimal residual disease detection in acute myeloid leukemia
  116. Hsa-miR-223-3p participates in the process of anthracycline-induced cardiomyocyte damage by regulating NFIA gene
  117. Anti-inflammatory effect of ApoE23 on Salmonella typhimurium-induced sepsis in mice
  118. Analysis of somatic mutations and key driving factors of cervical cancer progression
  119. Hsa_circ_0028007 regulates the progression of nasopharyngeal carcinoma through the miR-1179/SQLE axis
  120. Variations in sexual function after laparoendoscopic single-site hysterectomy in women with benign gynecologic diseases
  121. Effects of pharmacological delay with roxadustat on multi-territory perforator flap survival in rats
  122. Analysis of heroin effects on calcium channels in rat cardiomyocytes based on transcriptomics and metabolomics
  123. Risk factors of recurrent bacterial vaginosis among women of reproductive age: A cross-sectional study
  124. Alkbh5 plays indispensable roles in maintaining self-renewal of hematopoietic stem cells
  125. Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients
  126. Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer
  127. The protective effect of caffeic acid phenethyl ester in the nephrotoxicity induced by α-cypermethrin
  128. Norepinephrine alleviates cyclosporin A-induced nephrotoxicity by enhancing the expression of SFRP1
  129. Effect of RUNX1/FOXP3 axis on apoptosis of T and B lymphocytes and immunosuppression in sepsis
  130. The function of Foxp1 represses β-adrenergic receptor transcription in the occurrence and development of bladder cancer through STAT3 activity
  131. Risk model and validation of carbapenem-resistant Klebsiella pneumoniae infection in patients with cerebrovascular disease in the ICU
  132. Calycosin protects against chronic prostatitis in rats via inhibition of the p38MAPK/NF-κB pathway
  133. Pan-cancer analysis of the PDE4DIP gene with potential prognostic and immunotherapeutic values in multiple cancers including acute myeloid leukemia
  134. The safety and immunogenicity to inactivated COVID-19 vaccine in patients with hyperlipemia
  135. Circ-UBR4 regulates the proliferation, migration, inflammation, and apoptosis in ox-LDL-induced vascular smooth muscle cells via miR-515-5p/IGF2 axis
  136. Clinical characteristics of current COVID-19 rehabilitation outpatients in China
  137. Luteolin alleviates ulcerative colitis in rats via regulating immune response, oxidative stress, and metabolic profiling
  138. miR-199a-5p inhibits aortic valve calcification by targeting ATF6 and GRP78 in valve interstitial cells
  139. The application of iliac fascia space block combined with esketamine intravenous general anesthesia in PFNA surgery of the elderly: A prospective, single-center, controlled trial
  140. Elevated blood acetoacetate levels reduce major adverse cardiac and cerebrovascular events risk in acute myocardial infarction
  141. The effects of progesterone on the healing of obstetric anal sphincter damage in female rats
  142. Identification of cuproptosis-related genes for predicting the development of prostate cancer
  143. Lumican silencing ameliorates β-glycerophosphate-mediated vascular smooth muscle cell calcification by attenuating the inhibition of APOB on KIF2C activity
  144. Targeting PTBP1 blocks glutamine metabolism to improve the cisplatin sensitivity of hepatocarcinoma cells through modulating the mRNA stability of glutaminase
  145. A single center prospective study: Influences of different hip flexion angles on the measurement of lumbar spine bone mineral density by dual energy X-ray absorptiometry
  146. Clinical analysis of AN69ST membrane continuous venous hemofiltration in the treatment of severe sepsis
  147. Antibiotics therapy combined with probiotics administered intravaginally for the treatment of bacterial vaginosis: A systematic review and meta-analysis
  148. Construction of a ceRNA network to reveal a vascular invasion associated prognostic model in hepatocellular carcinoma
  149. A pan-cancer analysis of STAT3 expression and genetic alterations in human tumors
  150. A prognostic signature based on seven T-cell-related cell clustering genes in bladder urothelial carcinoma
  151. Pepsin concentration in oral lavage fluid of rabbit reflux model constructed by dilating the lower esophageal sphincter
  152. The antihypertensive felodipine shows synergistic activity with immune checkpoint blockade and inhibits tumor growth via NFAT1 in LUSC
  153. Tanshinone IIA attenuates valvular interstitial cells’ calcification induced by oxidized low density lipoprotein via reducing endoplasmic reticulum stress
  154. AS-IV enhances the antitumor effects of propofol in NSCLC cells by inhibiting autophagy
  155. Establishment of two oxaliplatin-resistant gallbladder cancer cell lines and comprehensive analysis of dysregulated genes
  156. Trial protocol: Feasibility of neuromodulation with connectivity-guided intermittent theta-burst stimulation for improving cognition in multiple sclerosis
  157. LncRNA LINC00592 mediates the promoter methylation of WIF1 to promote the development of bladder cancer
  158. Factors associated with gastrointestinal dysmotility in critically ill patients
  159. Mechanisms by which spinal cord stimulation intervenes in atrial fibrillation: The involvement of the endothelin-1 and nerve growth factor/p75NTR pathways
  160. Analysis of two-gene signatures and related drugs in small-cell lung cancer by bioinformatics
  161. Silencing USP19 alleviates cigarette smoke extract-induced mitochondrial dysfunction in BEAS-2B cells by targeting FUNDC1
  162. Menstrual irregularities associated with COVID-19 vaccines among women in Saudi Arabia: A survey during 2022
  163. Ferroptosis involves in Schwann cell death in diabetic peripheral neuropathy
  164. The effect of AQP4 on tau protein aggregation in neurodegeneration and persistent neuroinflammation after cerebral microinfarcts
  165. Activation of UBEC2 by transcription factor MYBL2 affects DNA damage and promotes gastric cancer progression and cisplatin resistance
  166. Analysis of clinical characteristics in proximal and distal reflux monitoring among patients with gastroesophageal reflux disease
  167. Exosomal circ-0020887 and circ-0009590 as novel biomarkers for the diagnosis and prediction of short-term adverse cardiovascular outcomes in STEMI patients
  168. Upregulated microRNA-429 confers endometrial stromal cell dysfunction by targeting HIF1AN and regulating the HIF1A/VEGF pathway
  169. Bibliometrics and knowledge map analysis of ultrasound-guided regional anesthesia
  170. Knockdown of NUPR1 inhibits angiogenesis in lung cancer through IRE1/XBP1 and PERK/eIF2α/ATF4 signaling pathways
  171. D-dimer trends predict COVID-19 patient’s prognosis: A retrospective chart review study
  172. WTAP affects intracranial aneurysm progression by regulating m6A methylation modification
  173. Using of endoscopic polypectomy in patients with diagnosed malignant colorectal polyp – The cross-sectional clinical study
  174. Anti-S100A4 antibody administration alleviates bronchial epithelial–mesenchymal transition in asthmatic mice
  175. Prognostic evaluation of system immune-inflammatory index and prognostic nutritional index in double expressor diffuse large B-cell lymphoma
  176. Prevalence and antibiogram of bacteria causing urinary tract infection among patients with chronic kidney disease
  177. Reactive oxygen species within the vaginal space: An additional promoter of cervical intraepithelial neoplasia and uterine cervical cancer development?
  178. Identification of disulfidptosis-related genes and immune infiltration in lower-grade glioma
  179. A new technique for uterine-preserving pelvic organ prolapse surgery: Laparoscopic rectus abdominis hysteropexy for uterine prolapse by comparing with traditional techniques
  180. Self-isolation of an Italian long-term care facility during COVID-19 pandemic: A comparison study on care-related infectious episodes
  181. A comparative study on the overlapping effects of clinically applicable therapeutic interventions in patients with central nervous system damage
  182. Low intensity extracorporeal shockwave therapy for chronic pelvic pain syndrome: Long-term follow-up
  183. The diagnostic accuracy of touch imprint cytology for sentinel lymph node metastases of breast cancer: An up-to-date meta-analysis of 4,073 patients
  184. Mortality associated with Sjögren’s syndrome in the United States in the 1999–2020 period: A multiple cause-of-death study
  185. CircMMP11 as a prognostic biomarker mediates miR-361-3p/HMGB1 axis to accelerate malignant progression of hepatocellular carcinoma
  186. Analysis of the clinical characteristics and prognosis of adult de novo acute myeloid leukemia (none APL) with PTPN11 mutations
  187. KMT2A maintains stemness of gastric cancer cells through regulating Wnt/β-catenin signaling-activated transcriptional factor KLF11
  188. Evaluation of placental oxygenation by near-infrared spectroscopy in relation to ultrasound maturation grade in physiological term pregnancies
  189. The role of ultrasonographic findings for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative breast cancer
  190. Construction of immunogenic cell death-related molecular subtypes and prognostic signature in colorectal cancer
  191. Long-term prognostic value of high-sensitivity cardiac troponin-I in patients with idiopathic dilated cardiomyopathy
  192. Establishing a novel Fanconi anemia signaling pathway-associated prognostic model and tumor clustering for pediatric acute myeloid leukemia patients
  193. Integrative bioinformatics analysis reveals STAT2 as a novel biomarker of inflammation-related cardiac dysfunction in atrial fibrillation
  194. Adipose-derived stem cells repair radiation-induced chronic lung injury via inhibiting TGF-β1/Smad 3 signaling pathway
  195. Real-world practice of idiopathic pulmonary fibrosis: Results from a 2000–2016 cohort
  196. lncRNA LENGA sponges miR-378 to promote myocardial fibrosis in atrial fibrillation
  197. Diagnostic value of urinary Tamm-Horsfall protein and 24 h urine osmolality for recurrent calcium oxalate stones of the upper urinary tract: Cross-sectional study
  198. The value of color Doppler ultrasonography combined with serum tumor markers in differential diagnosis of gastric stromal tumor and gastric cancer
  199. The spike protein of SARS-CoV-2 induces inflammation and EMT of lung epithelial cells and fibroblasts through the upregulation of GADD45A
  200. Mycophenolate mofetil versus cyclophosphamide plus in patients with connective tissue disease-associated interstitial lung disease: Efficacy and safety analysis
  201. MiR-1278 targets CALD1 and suppresses the progression of gastric cancer via the MAPK pathway
  202. Metabolomic analysis of serum short-chain fatty acid concentrations in a mouse of MPTP-induced Parkinson’s disease after dietary supplementation with branched-chain amino acids
  203. Cimifugin inhibits adipogenesis and TNF-α-induced insulin resistance in 3T3-L1 cells
  204. Predictors of gastrointestinal complaints in patients on metformin therapy
  205. Prescribing patterns in patients with chronic obstructive pulmonary disease and atrial fibrillation
  206. A retrospective analysis of the effect of latent tuberculosis infection on clinical pregnancy outcomes of in vitro fertilization–fresh embryo transferred in infertile women
  207. Appropriateness and clinical outcomes of short sustained low-efficiency dialysis: A national experience
  208. miR-29 regulates metabolism by inhibiting JNK-1 expression in non-obese patients with type 2 diabetes mellitus and NAFLD
  209. Clinical features and management of lymphoepithelial cyst
  210. Serum VEGF, high-sensitivity CRP, and cystatin-C assist in the diagnosis of type 2 diabetic retinopathy complicated with hyperuricemia
  211. ENPP1 ameliorates vascular calcification via inhibiting the osteogenic transformation of VSMCs and generating PPi
  212. Significance of monitoring the levels of thyroid hormone antibodies and glucose and lipid metabolism antibodies in patients suffer from type 2 diabetes
  213. The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study
  214. Interleukin 33, soluble suppression of tumorigenicity 2, interleukin 27, and galectin 3 as predictors for outcome in patients admitted to intensive care units
  215. Identification of diagnostic immune-related gene biomarkers for predicting heart failure after acute myocardial infarction
  216. Long-term administration of probiotics prevents gastrointestinal mucosal barrier dysfunction in septic mice partly by upregulating the 5-HT degradation pathway
  217. miR-192 inhibits the activation of hepatic stellate cells by targeting Rictor
  218. Diagnostic and prognostic value of MR-pro ADM, procalcitonin, and copeptin in sepsis
  219. Review Articles
  220. Prenatal diagnosis of fetal defects and its implications on the delivery mode
  221. Electromagnetic fields exposure on fetal and childhood abnormalities: Systematic review and meta-analysis
  222. Characteristics of antibiotic resistance mechanisms and genes of Klebsiella pneumoniae
  223. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series
  224. Vitamin C and epigenetics: A short physiological overview
  225. Ebselen: A promising therapy protecting cardiomyocytes from excess iron in iron-overloaded thalassemia patients
  226. Aspirin versus LMWH for VTE prophylaxis after orthopedic surgery
  227. Mechanism of rhubarb in the treatment of hyperlipidemia: A recent review
  228. Surgical management and outcomes of traumatic global brachial plexus injury: A concise review and our center approach
  229. The progress of autoimmune hepatitis research and future challenges
  230. METTL16 in human diseases: What should we do next?
  231. New insights into the prevention of ureteral stents encrustation
  232. VISTA as a prospective immune checkpoint in gynecological malignant tumors: A review of the literature
  233. Case Reports
  234. Mycobacterium xenopi infection of the kidney and lymph nodes: A case report
  235. Genetic mutation of SLC6A20 (c.1072T > C) in a family with nephrolithiasis: A case report
  236. Chronic hepatitis B complicated with secondary hemochromatosis was cured clinically: A case report
  237. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report
  238. Urokinase-based lock solutions for catheter salvage: A case of an upcoming kidney transplant recipient
  239. Two case reports of maturity-onset diabetes of the young type 3 caused by the hepatocyte nuclear factor 1α gene mutation
  240. Immune checkpoint inhibitor-related pancreatitis: What is known and what is not
  241. Does total hip arthroplasty result in intercostal nerve injury? A case report and literature review
  242. Clinicopathological characteristics and diagnosis of hepatic sinusoidal obstruction syndrome caused by Tusanqi – Case report and literature review
  243. Synchronous triple primary gastrointestinal malignant tumors treated with laparoscopic surgery: A case report
  244. CT-guided percutaneous microwave ablation combined with bone cement injection for the treatment of transverse metastases: A case report
  245. Malignant hyperthermia: Report on a successful rescue of a case with the highest temperature of 44.2°C
  246. Anesthetic management of fetal pulmonary valvuloplasty: A case report
  247. Rapid Communication
  248. Impact of COVID-19 lockdown on glycemic levels during pregnancy: A retrospective analysis
  249. Erratum
  250. Erratum to “Inhibition of miR-21 improves pulmonary vascular responses in bronchopulmonary dysplasia by targeting the DDAH1/ADMA/NO pathway”
  251. Erratum to: “Fer exacerbates renal fibrosis and can be targeted by miR-29c-3p”
  252. Retraction
  253. Retraction of “Study to compare the effect of casirivimab and imdevimab, remdesivir, and favipiravir on progression and multi-organ function of hospitalized COVID-19 patients”
  254. Retraction of “circ_0062491 alleviates periodontitis via the miR-142-5p/IGF1 axis”
  255. Retraction of “miR-223-3p alleviates TGF-β-induced epithelial-mesenchymal transition and extracellular matrix deposition by targeting SP3 in endometrial epithelial cells”
  256. Retraction of “SLCO4A1-AS1 mediates pancreatic cancer development via miR-4673/KIF21B axis”
  257. Retraction of “circRNA_0001679/miR-338-3p/DUSP16 axis aggravates acute lung injury”
  258. Retraction of “lncRNA ACTA2-AS1 inhibits malignant phenotypes of gastric cancer cells”
  259. Special issue Linking Pathobiological Mechanisms to Clinical Application for cardiovascular diseases
  260. Effect of cardiac rehabilitation therapy on depressed patients with cardiac insufficiency after cardiac surgery
  261. Special issue The evolving saga of RNAs from bench to bedside - Part I
  262. FBLIM1 mRNA is a novel prognostic biomarker and is associated with immune infiltrates in glioma
  263. Special Issue Computational Intelligence Methodologies Meets Recurrent Cancers - Part III
  264. Development of a machine learning-based signature utilizing inflammatory response genes for predicting prognosis and immune microenvironment in ovarian cancer
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